DETROIT (WWJ) – A pain management doctor from Metro Detroit has reached a settlement to resolve allegations that he and his medical clinics scammed Medicare and Medicaid by fraudulently billing them for three years..
Dr. Rajendra Bothra – owner and operator of The Pain Center USA, PLLC and Interventional Pain Center, PLLC in Eastpointe and Warren – have agreed to pay $6.5 million to settle the claims, U.S. Attorney Dawn Ison announced Monday.
Authorities say Bothra violated the federal False Claims Act between 2015-2018 by billing Medicare and Medicaid for “excessive and medically unnecessary presumptive and definitive urine drug tests that were not relevant to their patients’ diagnosis or treatment.”
There were also additional laboratory charges that were not separately billable with the urine drug tests, according to Ison’s office.
Additionally, Bothra and the pain centers allegedly billed Medicare and Medicaid for “medically unnecessary moderate sedation services.” Officials say patients were “routinely” sedated for procedures that did not require it.
Lastly, the government alleges they “frequently” charged Medicare and Medicaid for expensive back braces that were medically unnecessary or otherwise ineligible for reimbursement.
Prosecutors have called the case one of the worst healthcare scams in U.S. history. Bothra and several other doctors were acquitted of all criminal charges last year after prosecutors argued they "fed" the American opioid crisis with a $500 million scheme.
Ison says the settlement shows her office’s commitment to protect federal healthcare programs.
Devin Kowalski, Acting Special Agent in Charge of the FBI’s Detroit Field Office, says healthcare providers manipulating those programs “wastes resources meant to help those in need.”
Two separate lawsuits had been brought under the False Claims Act under provisions that allow a private party to file an action on behalf of the U.S. and receive a portion of any recovery.
Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800- HHS-TIPS (800-447-8477).
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